WHO broadens contraceptive guidance and backs research into male options

The World Health Organisation has expanded its recommended contraceptive options and said new reversible male contraceptive methods could become available within the next five to 10 years. The recommendations were announced in a news release on September 23 as part of updated guidance intended to help countries widen access to contraceptive methods supported by available evidence. The WHO said an estimated 164 million women who want to delay or avoid pregnancy are not using contraception.

Under the guidance, combined oral contraceptive pills may be used for extended periods of up to six months or continuously for up to one year, rather than only in cyclical patterns. The organisation also supports contraceptive implants for as long as five years, saying this could reduce replacement procedures, clinic visits and related costs. The WHO has further recommended mifepristone as an additional emergency contraception option.

It should be taken as soon as possible and within five days of unprotected sex. The organisation said evidence indicated that doses of 10–50mg were likely to be as safe and effective as other emergency contraceptive methods. “Choice is a gender equality issue,” Pascale Allotey, director of the WHO department responsible for sexual and reproductive health, said.

She added that contraception was not suited to a single approach and that users needed options reflecting considerations including convenience, reliability, accessibility and invasiveness. The organisation is also seeking to expand methods available to men, who currently have relatively few options under their control, principally condoms, withdrawal and vasectomy. The WHO said about 30% of couples rely on a male method despite the limited choice.

It said surveys showed more than 75% of couples would be willing to use a new male contraceptive, while more than 85% of women surveyed said they would trust their male partners to take responsibility. The WHO has produced its first target product profile for male contraceptives, covering safety, effectiveness, acceptability and affordability. The organisation said hormonal and non-hormonal candidates were in development, with several in advanced clinical trials.

It also called for more research before ormeloxifene is included in family-planning programmes and advised against quinestrol-containing pills because of limited evidence and reports of serious adverse events.